#MedTwitter #tweetorial #lymsm #PCNSL #NHL #CNSTo200M #NCA 1 NHL a week Series.
Let us have a small summary /
#tweetorial on Primary CNS Lymphomas
https://abs.twimg.com/emoji/v2/... draggable="false" alt="1⃣" title="Tastenkappe Ziffer 1" aria-label="Emoji: Tastenkappe Ziffer 1">
https://abs.twimg.com/emoji/v2/... draggable="false" alt="⚡️" title="Hochspannungszeichen" aria-label="Emoji: Hochspannungszeichen">PCNSL - confined to brain, leptomeninges,eyes,spinal cord.
https://abs.twimg.com/emoji/v2/... draggable="false" alt="⚡️" title="Hochspannungszeichen" aria-label="Emoji: Hochspannungszeichen">~ 2% of primary CNS tumors.
https://abs.twimg.com/emoji/v2/... draggable="false" alt="⚡️" title="Hochspannungszeichen" aria-label="Emoji: Hochspannungszeichen">median age-65y
https://abs.twimg.com/emoji/v2/... draggable="false" alt="⚡️" title="Hochspannungszeichen" aria-label="Emoji: Hochspannungszeichen">mc presentation: Focal neurologic deficits
https://abs.twimg.com/emoji/v2/... draggable="false" alt="⚡️" title="Hochspannungszeichen" aria-label="Emoji: Hochspannungszeichen">Imaging choice : Contrast-enh MRI
https://abs.twimg.com/emoji/v2/... draggable="false" alt="🚩" title="Dreieckige Fahne an einem Pfosten" aria-label="Emoji: Dreieckige Fahne an einem Pfosten">Predictors of poor prognosis:age>60 y,ECOG>1,
https://abs.twimg.com/emoji/v2/... draggable="false" alt="⏫" title="Nach oben zeigendes doppeltes Dreieck" aria-label="Emoji: Nach oben zeigendes doppeltes Dreieck">LDH,
https://abs.twimg.com/emoji/v2/... draggable="false" alt="⏫" title="Nach oben zeigendes doppeltes Dreieck" aria-label="Emoji: Nach oben zeigendes doppeltes Dreieck">CSF protein ,inv of deep areas
https://abs.twimg.com/emoji/v2/... draggable="false" alt="2⃣" title="Tastenkappe Ziffer 2" aria-label="Emoji: Tastenkappe Ziffer 2">PATHOLOGY (1):
https://abs.twimg.com/emoji/v2/... draggable="false" alt="⚡️" title="Hochspannungszeichen" aria-label="Emoji: Hochspannungszeichen">90% –DLBCL
https://abs.twimg.com/emoji/v2/... draggable="false" alt="⚡️" title="Hochspannungszeichen" aria-label="Emoji: Hochspannungszeichen">Rest :T-NHL, poorly characterized low-grade NHL, or Burkitt&
#39;s
https://abs.twimg.com/emoji/v2/... draggable="false" alt="⚡️" title="Hochspannungszeichen" aria-label="Emoji: Hochspannungszeichen">> 90% PCNS DLBCL-ABC subtype
https://abs.twimg.com/emoji/v2/... draggable="false" alt="💡" title="Elektrische Glühbirne" aria-label="Emoji: Elektrische Glühbirne">NEWER INSIGHTS :The B-cell receptor (BCR) signaling axis with its downstream target,NFkB, is affected by mutations in MYD88, CD79B &rarely CARD11.
https://abs.twimg.com/emoji/v2/... draggable="false" alt="3⃣" title="Tastenkappe Ziffer 3" aria-label="Emoji: Tastenkappe Ziffer 3">PATHOLOGY CONT(2)
https://abs.twimg.com/emoji/v2/... draggable="false" alt="⚡️" title="Hochspannungszeichen" aria-label="Emoji: Hochspannungszeichen">notable risk factor - immunodeficiency
https://abs.twimg.com/emoji/v2/... draggable="false" alt="⚡️" title="Hochspannungszeichen" aria-label="Emoji: Hochspannungszeichen">HIV infection, iatrogenic immune suppression, and congenital immune deficiency
https://abs.twimg.com/emoji/v2/... draggable="false" alt="💡" title="Elektrische Glühbirne" aria-label="Emoji: Elektrische Glühbirne">PCNSL may be a consequence of EBV-mediated clonal expansion and malignant transformation of B-lymphocytes
https://abs.twimg.com/emoji/v2/... draggable="false" alt="4⃣" title="Tastenkappe Ziffer 4" aria-label="Emoji: Tastenkappe Ziffer 4">PATHOLOGY CONT (3)
https://abs.twimg.com/emoji/v2/... draggable="false" alt="⚡️" title="Hochspannungszeichen" aria-label="Emoji: Hochspannungszeichen">Most PCNSL cells demonstrate IgHV genes that have high levels of somatic mutations and show intraclonal heterogeneity pointing towards their derivation from mutated germinal center B cells
Here is a bonus tweet of pathology in PCNSL
https://twitter.com/anjuthevirgo/status/1293285265964822528?s=20">https://twitter.com/anjuthevi...
https://abs.twimg.com/emoji/v2/... draggable="false" alt="5⃣" title="Tastenkappe Ziffer 5" aria-label="Emoji: Tastenkappe Ziffer 5">MANAGEMENT :
Rx: IV HD-MTX at var doses (1–8 g/m2) with other chemotherapeutic agents and/or WBRT
-no consensus on the optimal dose of MTX/on the role of radiation
-Rituximab is incorporated in these regimes.
Here is an awesome yet simplified approach
@UpToDate based on age
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https://abs.twimg.com/emoji/v2/... draggable="false" alt="⚡️" title="Hochspannungszeichen" aria-label="Emoji: Hochspannungszeichen">NOVEL Insights :
https://abs.twimg.com/emoji/v2/... draggable="false" alt="🚩" title="Dreieckige Fahne an einem Pfosten" aria-label="Emoji: Dreieckige Fahne an einem Pfosten">Modulators of BCR pathway:
https://abs.twimg.com/emoji/v2/... draggable="false" alt="💡" title="Elektrische Glühbirne" aria-label="Emoji: Elektrische Glühbirne">BTK inhibitor-ibrutinib
https://abs.twimg.com/emoji/v2/... draggable="false" alt="💡" title="Elektrische Glühbirne" aria-label="Emoji: Elektrische Glühbirne">IMiDs like lenalidomide because of inhibition of NF-κB activity+PI3K/AKT pathway
in relapsed refractory cases is promising
https://abs.twimg.com/emoji/v2/... draggable="false" alt="‼️" title="Doppeltes Ausrufezeichen" aria-label="Emoji: Doppeltes Ausrufezeichen">
https://abs.twimg.com/emoji/v2/... draggable="false" alt="💡" title="Elektrische Glühbirne" aria-label="Emoji: Elektrische Glühbirne">Observation of altered PD-L1gene has led to trials of Nivolumab in PCNSL
https://abs.twimg.com/emoji/v2/... draggable="false" alt="7⃣" title="Tastenkappe Ziffer 7" aria-label="Emoji: Tastenkappe Ziffer 7"> NOTEWORTHY POINTS:
https://abs.twimg.com/emoji/v2/... draggable="false" alt="⚡️" title="Hochspannungszeichen" aria-label="Emoji: Hochspannungszeichen">If possible,biopsy shud b done before steroids
https://abs.twimg.com/emoji/v2/... draggable="false" alt="❗️" title="Rotes Ausrufezeichen" aria-label="Emoji: Rotes Ausrufezeichen">
https://abs.twimg.com/emoji/v2/... draggable="false" alt="⚡️" title="Hochspannungszeichen" aria-label="Emoji: Hochspannungszeichen">Therapy-high dose MTX atleast@3.5g/m2
https://abs.twimg.com/emoji/v2/... draggable="false" alt="⚡️" title="Hochspannungszeichen" aria-label="Emoji: Hochspannungszeichen">Despite inadequate data supporting rituximab, excellent tolerability+good results in prospective trials, RTX may be favored IN front line RX
https://abs.twimg.com/emoji/v2/... draggable="false" alt="⚡️" title="Hochspannungszeichen" aria-label="Emoji: Hochspannungszeichen">DONOT FORGET TESTIS
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https://abs.twimg.com/emoji/v2/... draggable="false" alt="8⃣" title="Tastenkappe Ziffer 8" aria-label="Emoji: Tastenkappe Ziffer 8">COMMONLY USED PROTOCOLS
We prefer using the R-MPV protocol in our centre.
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MANAGEMENT :Rx: IV HD-MTX at var doses (1–8 g/m2) with other chemotherapeutic agents and/or WBRT-no consensus on the optimal dose of MTX/on the role of radiation -Rituximab is incorporated in these regimes.Here is an awesome yet simplified approach @UpToDate based on age" title="https://abs.twimg.com/emoji/v2/... draggable="false" alt="5⃣" title="Tastenkappe Ziffer 5" aria-label="Emoji: Tastenkappe Ziffer 5">MANAGEMENT :Rx: IV HD-MTX at var doses (1–8 g/m2) with other chemotherapeutic agents and/or WBRT-no consensus on the optimal dose of MTX/on the role of radiation -Rituximab is incorporated in these regimes.Here is an awesome yet simplified approach @UpToDate based on age">
MANAGEMENT :Rx: IV HD-MTX at var doses (1–8 g/m2) with other chemotherapeutic agents and/or WBRT-no consensus on the optimal dose of MTX/on the role of radiation -Rituximab is incorporated in these regimes.Here is an awesome yet simplified approach @UpToDate based on age" title="https://abs.twimg.com/emoji/v2/... draggable="false" alt="5⃣" title="Tastenkappe Ziffer 5" aria-label="Emoji: Tastenkappe Ziffer 5">MANAGEMENT :Rx: IV HD-MTX at var doses (1–8 g/m2) with other chemotherapeutic agents and/or WBRT-no consensus on the optimal dose of MTX/on the role of radiation -Rituximab is incorporated in these regimes.Here is an awesome yet simplified approach @UpToDate based on age">
COMMONLY USED PROTOCOLSWe prefer using the R-MPV protocol in our centre." title="https://abs.twimg.com/emoji/v2/... draggable="false" alt="8⃣" title="Tastenkappe Ziffer 8" aria-label="Emoji: Tastenkappe Ziffer 8">COMMONLY USED PROTOCOLSWe prefer using the R-MPV protocol in our centre." class="img-responsive" style="max-width:100%;"/>
